Yüksek Nemli Dane Mısıra Bakteriyel İnokulant İlavesinin Silolama Süresi ve Aerobik Stabilitesi Üzerine Etkileri

Bu çalışma, yüksek nemli dane mısıra homofermantatif + heterofermantatif özelliklere sahip iki farklı inokulantın ilave edilmesinin, farklı açım dönemlerinde (15 ve 30 gün) fermantasyon ve aerobik stabilite üzerine etkilerini belirlemek amacıyla düzenlenmiştir. Araştırma materyalini yaklaşık %64.84 kuru madde (KM) içeriğine sahip kırılmış yüksek nemli dane mısır oluşturmuştur. Laktik asit bakteri inokulantı olarak Pioneer 11CFT (Lactobacillus plantarum ATCC 55944, Lactobacillus buchneri ATCC PTA-6138) ve Lalsil combo (Lactobacillus plantarum CNCM MA 18/5U, Lactocbacillus buchneri NCIMB 40788) kullanılmıştır. İnokulant firma önerisi doğrultusunda silajlara ilave edilmiştir. Katkı maddesi ilavesinden sonra silaj örnekleri her muamele grubunda 5’er tekerrür olmak üzere plastik torbalara vakumlanarak doldurulmuştur. Paketler laboratuvar koşullarında 20 ± 2 °C sıcaklıkta depolanmışlardır. Fermantasyonun 15. ve 30. günü açılan silaj örneklerinde kimyasal ve mikrobiyolojik analizler yapılmıştır. Açım dönemi sonrası silajlara 5 günlük aerobik stabilite testi uygulanmıştır. Araştırma sonucunda, silolama süresine bağlı olarak silajların pH değeri, amonyağa bağlı nitrojen (NH3-N), suda çözünebilir karbonhidrat (SÇK), lactobacilli (LAB) ve maya içerikleri artarken, KM içerikleri ise düşmüştür (P< 0.001). Katkı maddesi ilaveli silajların, NH3-N, SÇK, laktik asit (LA), LAB ve maya içerikleri kontrol grubu silajlarına oranla daha yüksek, pH değerleri ise daha düşük tespit edilmiştir (P<0.001). Aerobik stabilite dönemi üzerinde silolama süresi etkili olmuş, süreye bağlı olarak silajların pH değeri, karbondioksit (CO2) üretimi ve maya içerikleri düşmüştür (P<0.001). Aerobik stabilite döneminde Pioneer 11CFT inokulantı kullanılan yüksek nemli dane mısır silajlarında CO2 üretimini azaltmıştır. Katkı maddesi ilaveli silajların aerobik stabilite döneminde maya içerikleri arttırmıştır, ancak katkı maddesi ilavesi küf gelişimini ise tamamen önlemiştir. Yüksek nemli dane mısır silajlarına, katkı maddesi ilave edilmesinin özellikle küf gelişimini önlemesi araştırmanın önemli bulgulardan birisidir

The effect of STEM education practices on academic achievement and scientific process skills: A meta-analysis study

Today's education systems, where scientific knowledge is rapidly transformed into technology, develop new teaching methods to develop the individuals needed by societies. STEM education is an application that has been proposed in the past years and enables individuals to become literate individuals in the fields of science, technology, engineering, and mathematics. The effects of STEM education based on these four disciplines on individuals' academic achievement and scientific process skills have been examined in many studies in the literature. In this direction, it is important to make a general evaluation of these studies in the literature and to make a cumulative evaluation of STEM education studies. Therefore, this study aims to perform a meta-analysis of postgraduate theses that examine the effect on academic achievement or scientific process skills based on STEM education practices. The study was conducted in phases using the PRISMA flow model. Graduate theses were published in the National Thesis Centre in 2017 and later were analysed within the framework of the inclusion criteria. As a result of the study, it was determined that STEM practices contribute positively to academic achievement and scientific process skills. As a result of the results of the study, suggestions were made for the meta-analysis of studies investigating the relationship between STEM education practices in different contexts

Difficulties in diagnosis and treatment in cases with neuroglycopenia symptoms: A case of insulinoma

47 yaşında bayan hastada gözlerde kayma, terleme, son 6 aydır tekrarlayan bayılmalar, idrarını kaçırma, dilini ısırma şikayetleri mevcuttu. Diyabet öyküsü yoktu. Konvülziyon esnasında ölçülen kan şekeri 30mg/dl bulundu. Oral glikoz tolerans testinde üçüncü saat kan şekeri değeri 44mg/dl olarak düşük bulundu ve hipoglisemi belirtileri saptandı. Simultan ölçülen insulin düzeyi 36U/ml (1-25U/ml) ve C-peptid düzeyi 6.2 ng/ml (0.9-4ng/ml) olarak yüksek bulundu. Üst batın magnetik rezonans incelemesinde; pankreas uncinate proces infero-medial komşuluğunda yaklaşık iki santimetrelik kontrast tutulumu olan kuşkulu nodüler alan görüldü. Selektif çölyak angiografisinde pankreas başı lokalizasyonunda hipervasküler karakterde solid nodüler kitle tespit edildi. Hastadan tümöral kitle çıkarıldı. Patolojisinde belirgin gland yapısının bulunmadığı soliter yapıda tümör dokusu izlendi. Yapılan immunhistokimyasal panelde synaptophysin, nöronspesifik enolaz, kromogranin ve insülin ile pozitif boyanma gösterdiği saptandı. Ciddi nöroglikopenik semptomları bulunan ve diyabet öyküsü bulunmayan olguların ayırıcı tanısında mutlaka insulinoma düşünülmelidir.A 47 year-old female patient presented with complaints of strabismus, sweating, enuresis tongue biting and repetitive fainting in the last 6 months. She had no history of diabetes. A blood glucose level measured during an acute episode was 30 mg/dL. In the oral glucose tolerance test, the blood glucose level at 3 h was found to be with 44 mg/dL and the signs of hypoglycemia were detected. Simultaneously measured insulin and C-peptide levels were found to be high at 36 U/ml (1-25 U/ml) and 6.2 ng/ml (0.9-4 ng/ml), respectively). On the examination of the upper abdomen using magnetic resonance imaging, a suspicious nodular area with approximately 2cm of contrast involvement was detected neighboring the inferomedial side of the uncinate process of the pancreas. By selective celiac angiography, a solid nodular mass with a hypervascular character located in the head of pancreas was detected. The tumoral mass was excised and tissue of solitary structure with no glandular structure was observed in the pathology. It stained positively with synaptophysine, neuronspecific enolase, chromogranine and insulin.In the differential diagnosis of the patients with serious neuroglycopenic symptoms without diabetes history, insulinoma should always be considered

Laparoscopic Approach To Obturator Lymph Node Positivity in Positron Emission Tomography Assisted Computerized Tomography (PET-CT) of a Preoperative Stage 1B1 Cervical Cancer Patient

Objective: Although positron emission tomography assisted computerized tomography (PET-CT) is used to evaluate staging, treatment planning and prognosis in cervical cancer, its definite role is not established. It is especially used to rule out lymph node and distant metastasis in early stage cervical cancer patients who are candidates for radical hysterectomy. Recent literature suggests that by doing so unnecessary surgery, in patients who will ultimately require radiotherapy, would be prevented. We are presenting a case of cervical cancer patient preoperatively staged as 1B1 but revealed a lymph node positivity in PET-CT scan in left obturator fossa. She had a laparoscopic lymph node dissection and frozen section. Setting: University clinic. Results: A 52-year-old postmenopausal woman with a complaint of frequent spotting was diagnosed to have stage 1B1 squamous carcinoma of the cervix of 1.5 cm in diameter. Her preoperative PET-CT revealed a positivity in left obturator fossa suggesting metastasis in addition to cervical uptake. She was planned to have a radical hysterectomy if laparoscopic lymph node dissection and frozen section were negative for malignancy. Intra-operative frozen section of a 1 cm lymph node from the left obturator fossa was positive for metastasis. The decision of radical hysterectomy was abandoned and she was referred to concomitant chemoradiotherapy. Interestingly, her final pathology revealed an additional microscopic metastasis in one of right pelvic lymph nodes that was sampled during the operation. Conclusions: If PET-CT scan is negative for lymph node metastasis, these patients have low risk for postoperative radiotherapy after radical hysterectomy. In accordance with current literature, microscopic lymph node metastasis may not be revealed by PETCT, as it was in our case. If PET-CT reveals metastatic uptake, laparoscopic lymph node sampling and frozen section may be helpful in confirming metastatic disease. PET-CT seems to be beneficial in planning therapy preoperatively in cervical cancer

The effects of postoperative analgesia techniques on gastrointestinal system functions after lower abdominal surgery

Amaç. Bu çalışmanın amacı, genel anestezi altında yapılan sezaryen veya abdominal histerektomi operasyonlarında, postoperatif analjezi tekniklerinin, gastrointestinal sistem fonksiyonlarına etkilerinin karşılaştırılmasıdır. Yöntem. Etik kurul ve hastaların onayı alındıktan sonra genel anestezi altında sezaryen veya abdominal histerektomi yapılacak 75 hasta rasgele 5 gruba ayrıldı. Postoperatif dönemde Grup I’e 6 saat ara ile 1mg/kg meperidin intramusküler uygulandı. Grup II’ye 1 mg/kg meperidin ve 75 mg diklofenak sodyum kombinasyonu intramusküler yöntemle 12 saat ara ile uygulandı. Grup III’e hasta kontrollü analjezi ile morfin hidroklorür 3 mg yükleme dozunda, bolus doz 1 mg ve kilitli kalma süresi 20 dakika olacak şekilde intravenöz uygulandı. Grup IV’e epidural kateterden 7 mL %0,5’lik bupivakain ile birlikte 2 mg morfin bolus dozda verildi. Bupivakainin %0.1’lik konsantrasyonunun ve morfinin 0,03 mg/mL’lik konsantrasyonundan oluşan kombinasyon 6-8 mL/saat dozunda sürekli infüzyon şeklinde uygulandı. Grup V’e epidural kateterden 3mg morfin bolus verildi. Morfinin 0,05 mg/mL’lik solüsyonundan 6-8 mL/saat dozunda sürekli infüzyon şeklinde uygulandı. Postoperatif hemodinamik veriler, sedasyon ve VAS skorları, ilk barsak hareketi, gaz-gayta çıkım zamanı, oral alım zamanları, ek analjezik gereksinimi ve yan etkiler kaydedildi. Bulgular. Gruplar arasında demografik özellikler ve hemodinamik veriler yönünden fark yoktu (p>0,05). Grup IV ve V de VAS skorları diğer gruplardan daha düşüktü. Sedasyon skorları grup III, IV, V de diğer gruplara göre daha yüksek gözlenmiştir (p<0,05). Postoperatif barsak hareketleri, gaz gayta çıkımı ve oral gıda alımı en erken Grup II ve Grup IV’de görüldü (p<0,05). Grup III, IV ve V‘ de diğer grupların aksine postoperatif metamizol gereksinimi olmadı (p<0,05). Sonuç. Sonuç olarak, epidural yoldan bupivakain - morfin uygulamasının postoperatif dönemdeki analjezik etkinlik ve gastrointestinal fonksiyonların düzelmesi açısından daha avantajlı olduğu kanaatine varıldı.Aim. The aim of this study was to compare the effects of postoperative analgesia techniques on gastrointestinal system functions at caesarean section or abdominal hysterectomy under general anesthesia. Method. After the permission of patients and Ethical committee, 75 patients that will undergo cesarian sectio or abdominal hysterectomy under general anesthesia, divided randomly into five groups. Group I patients were given intramuscular meperidine 1 mg/kg/6h postoperatively. Group II patients were given intramuscular meperidine 1 mg/kg/12h combined with 75 mg diclofenac sodium. Group III patients were given intravenous patient controlled analgesia with morphine hydrochlorur 3 mg initial bolus dose and 1 mg maintenance dose with 20 minutes lock out time. Group IV patients were applied epidural 7 mL 0.5% bupivacaine and 2mg morphine then given an infusion of 0.1% bupivacaine and 0.03 mg/mL morphine with rate of 6-8 mL/h. Group V patients were applied epidural 3 mg morphine then given an infusion of 0.05 mg/mL morphine. Postoperative hemodynamic data, sedation and VAS scores, the first bowel movement, time of gas and feces output, time of oral intake, additional analgesic requirements and side effects were recorded. Results. The demographic characteristics and hemodynamic data did not differ between groups (p&gt; 0.05). Group IV and V, had the lower VAS scores than the others (p&lt;0.05). Sedation scores were higher at Group III, IV, V than the other groups (p&lt;0.05). Postoperative bowel movements, gas and feces output, oral food intake were seen earliest in Group II and Group IV (p&lt;0.05). Group III, IV and V did not need metamizol postoperatively unlike the others (p&lt;0.05). Conclusion. Finally, it was concluded that epidural bupivacaine - morphine application is more advantageous in postoperative analgesic efficacy and improvement of gastrointestinal functions

Vancomycin Resistant Enterococcus Outbreak in a University Hospital: Investigation of Risk Factors

Introduction: In this study, independent risk factors for the acquisition of vancomycin resistant enterococcus (VRE) were investigated prospectively between September 2011 and March 2012 in a nosocomial VRE outbreak at a university hospital. Materials and Methods: After the detection of a VRE strain from wound culture sample of an inpatient in September 2011, a VRE outbreak was assumed in the hospital, and VRE surveillance was performed both at high-risk and VRE detected clinics. For the detection of gastrointestinal system (GIS) VRE colonization, weekly rectal swab specimens were taken from the hospitalized patients and when considering an infection, blood, urine and wound specimens were sent to the microbiology laboratory for each patient. The patients whom rectal swab and/or clinical specimens yielded VRE were accepted as VRE positive. Determining vancomycin resistance genotype among the VRE strains were done with multiplex polymerase chain reaction technique (GenExpert®, USA) by using the special test kits (Xpert®, USA). Results: During the seven-month of VRE outbreak, a total of 74 VRE positive patients, 6 (8.1%) of whom infected by a VRE in seven different clinics were determined. These 74 VRE positive patients and 1136 patients who were accepted as VRE negative (all were hospitalized in the same clinical wards) by the surveillance cultures were divided into two groups for comparing patient characteristics. A multivariate logistic regression analysis showed sulbactam-ampicillin [Odds ratio (OR) 3.18, 95% confi dence interval (95% CI) 1.70-5.97; p< 0.001], vancomycin (OR 5.16, 95% CI 1.92-13.9; p= 0.001), piperacillin/tazobactam (OR 4.09, 95% CI 1.85-9.45; p= 0.001), carbapenems (imipenem, meropenem) (OR 2.43, 95% CI 2.03-10.1; p< 0.001) and amikacin (OR 7.4, 95% CI 2.71-20.19; p< 0.001) use, all were detected as independent risk factors for VRE positivity. Further, diabetes mellitus (OR 2.44, 95% CI 1.31-4.53; p= 0.005), abdominal surgical operation (OR 2.49, 95% CI 1.18-5.29; p= 0.017), and the application of a nasogastric feeding tube (OR 0.31, 95% CI 0.13- 0.75; p= 0.01) were also determined as independent risk factors for VRE-acquisition. Seventy-three out (98.6%) of 74 VRE strains were both vancomycin [minimum inhibitor concantration (MIC) > 16 μg/mL)] and teicoplanin (MIC > 16 μg/mL) resistant (vanA genotype) Enterococcus faecium. Conclusion: The use of parenteral form of broad spectrum antibiotics and underlying diseases like diabetes and nasogastric tube applications, all increase nosocomial VRE risk